Pain guide · Elbow pain

Elbow OCD (osteochondritis dissecans): outer elbow pain in young throwers and gymnasts, and Panner's disease

Elbow osteochondritis dissecans (OCD) is damage to a patch of bone and the cartilage over it on the outer side of the elbow joint, from repeated throwing or weight-bearing on the hands. It mostly affects young throwers and gymnasts aged about 10 to 17, can be painless at first, and shows as outer elbow pain, lost straightening and, later, catching or locking. Panner's disease is a gentler relative in children under about 10.

Whether the lesion is stable or unstable decides the treatment, and imaging decides that. Stable lesions usually heal with months off throwing and weight on the hands, while unstable ones and loose pieces often need surgery, so a specialist leads the care. This guide is for young athletes, parents and coaches: the same-day signs, the scans, realistic healing times, and a staged plan with 3D demos for throwers and gymnasts, as the specialist allows.

4-stage exercise plan When to get help 33 sourcesUpdated 21 October 2026

When to get help first

Exercise is for pain that has been checked or is clearly mild and settling.

Get urgent medical help if

Go to A&E or call 999 if you've injured your arm and it is numb, tingling or has pins and needles; a bone is sticking out or a bad cut is bleeding heavily; or the arm or elbow has changed colour or shape, or is at an odd angle. Don't drive yourself.
Same day: the elbow locks or catches, or suddenly can't fully bend or straighten. A loose piece of bone or cartilage, or damage to the joint surface on the outer side of the elbow, can do this.
Urgent treatment centre or A&E: severe pain in your arm and it's difficult to move, or you've injured your arm and heard a snap. Tingling or numbness that comes on suddenly or after an injury belongs here too.
Same day (urgent GP appointment or NHS 111): a swollen elbow with a very high temperature, or you feel hot, cold or shivery; or sudden severe pain in one joint with swelling, a change of colour and difficulty moving it. It could be an infection in the joint or the bursa, or gout.
While it heals, get help from NHS 111 the same day if the pain gets worse; your temperature is very high or you feel hot, cold or shivery; the cast or splint breaks or feels too tight or too loose; your fingers or hand feel numb, look swollen, or turn blue or white; or there is a bad smell or fluid coming from under the cast.
After an operation, oozing or pus from the wound: ask for an urgent GP appointment or get help from NHS 111. If you feel unwell or feverish and the wound looks infected, go to A&E.
Throbbing pain and swelling in the arm, with red, blue or darker skin and swollen veins: ask for an urgent GP appointment or get help from NHS 111. It could be a blood clot.
Arm pain or swelling with breathlessness or chest pain: call 999 or go to A&E, and do not drive yourself. It can be a blood clot that has reached the lungs.

See a doctor or physiotherapist if

Pain on the outside of the elbow in a child or teenager who throws or does gymnastics: stop throwing and weight on the hands, and see a GP or sports physiotherapist. X-rays can miss early OCD, and early, stable lesions heal best.
An elbow that won't straighten as far as the other one, clicks, or swells after training: get it checked. These can mean the lesion is loosening.
Pain that comes back when throwing or gymnastics restarts: stop again and go back to the specialist.
A child under 10 with outer elbow pain and stiffness: see a GP. It may be Panner's disease, which needs rest from loading the arm and usually nothing more.
Pain at night or at rest, a fever, weight loss, or swelling in both elbows. These aren't typical of an overuse injury and need a GP.
Elbow pain in a child or teenager, a swelling or lump, or pain and swelling in several joints. A UK care pathway lists these as reasons for referral rather than routine tennis elbow care.
Pins and needles that keep coming back or are constant, numbness in the ring and little fingers that doesn't go, a weak or clumsy hand, or visible wasting between the thumb and index finger. Ask about referral: one NHS referral guide treats permanent numbness or wasting as urgent.

Understand it

What it is

The capitellum is the rounded outer part of the lower end of the upper arm bone, where the head of the radius presses against it. In a growing child its bone forms gradually and its blood supply is limited. Repeated squashing and shearing damage the bone under the cartilage, which softens, cracks and can separate, taking cartilage with it. A piece that comes free can float in the joint as a loose body.

Throwing squashes the outer elbow as the arm comes forward. Gymnastics loads it through a straight elbow in handstands, vault and tumbling, so gymnasts' lesions sit further back on the capitellum than throwers' (28° against 57.6° from the bone's long axis).

Sources 1, 2, 3, 4, 5, 6

Who gets it

Young athletes aged about 10 to 17: boys who throw, and gymnasts, who are often girls. In one US children's hospital's group of 154, 39% were gymnasts and 28.5% played baseball or softball. In a US population, it was diagnosed in 6.0 per 100,000 people aged 10 to 24 each year, and in 15.3 per 100,000 boys aged 10 to 15; 89% did sport, and 90% of those did overhead sports.

Ultrasound screening of Japanese baseball players found it in 1.4% of 6 to 12 year olds, 2.1% of 10 to 12 year olds and 3.4% of 12 to 18 year olds, and 1.8% of 6 to 11 year olds developed it within a year. In 31 healthy high-level gymnasts, 15 of 62 elbows showed changes in the capitellum on ultrasound, often in both arms, and about 10% of gymnasts with OCD have it in both elbows.

Sources 2, 7, 8, 9, 10, 11, 12, 13, 3

How it's recognised

Pain on the outer elbow with throwing, lifting or weight on the hands, often for months before anyone looks at it; losing some straightening; and later swelling, clicking, catching or locking. The examination checks tenderness on the outer elbow, movement compared with the other arm, and catching.

Many lesions don't hurt at first. Of the children found by screening in three Japanese programmes, 34.4%, 34.8% and 68% had ever had elbow pain. Inner elbow pain in a young thrower is usually Little League elbow, which has its own guide; the two can happen together, so outer elbow pain needs checking even when the inner side hurts most.

Sources 1, 3, 2, 14, 9, 12, 10, 6

Stable or unstable: imaging decidesEmerging evidence

X-rays come first, including a view with the elbow bent to 45° for throwers and a straighter view for gymnasts. But they miss early lesions: routine X-rays showed OCD on first reading in 7 of 15 confirmed cases, and loose bodies in 3 of 7. In another group, X-rays found 27% and magnetic resonance imaging (MRI) 40% of the loose bodies later seen at surgery.

MRI decides stability. Experts agree that intact cartilage, no fluid behind the lesion, unbroken bone and no displaced piece suggest a stable lesion; broken cartilage or bone, fluid beneath the cartilage, a displaced piece and loose bodies suggest an unstable one, which is unlikely to heal without surgery. In an older classification still in use, stable lesions had an open growth plate, early changes and good movement, and healed with rest; unstable lesions had a closed growth plate, a broken-up fragment or 20° or more of lost movement, and did better with surgery.

In Japan, ultrasound screening finds lesions early: 65.8% of players flagged by ultrasound were confirmed to have OCD, against 1.9% of those flagged by an examination alone.

Sources 15, 5, 16, 17, 18, 19, 9

What scans can mistake for OCDEmerging evidence

In baseball players under 10, irregular areas on the capitellum on ultrasound (3.4% of 321) had all gone 2 years later while the children kept throwing: a normal stage of bone growth. On MRI, a normal notch at the back of the capitellum appeared in 14 of 22 volunteers without symptoms. And 24% of healthy high-level gymnasts' elbows showed capitellum changes on ultrasound, linked with tenderness but not with how well the elbow worked.

Sources 20, 21, 13

How it usually goesEmerging evidence

Stable lesions heal with rest, slowly: 90.5% of early lesions healed in one group, but healing on X-ray took 14.9 months on average, and 16 of 17 children with an open growth plate healed in another. Unstable lesions rarely heal without surgery: 1 of 9 advanced lesions healed, and non-surgical care failed in 70% of a US group, especially with a loose body.

After surgery, most return to their sport (76% to 81%), usually at about 6 months, and about 1 in 9 needs another operation. Long term, 54% of 24 young people in an older series treated with 6 months of rest had elbow pain with daily activities 5 years later, and in a US group followed for over 10 years, elbows treated surgically had better function and fewer catching or locking symptoms (9% against 50%).

Sources 15, 22, 17, 7, 23, 24, 25

Panner's diseaseEmerging evidence

Panner's disease affects the whole capitellum in children under about 10, usually boys (90% of 30 reported cases), usually in the dominant arm. On X-ray the capitellum looks smaller and broken up, but there is no loose piece and no cartilage damage, and it remodels. Pain, swelling and losing about 20° of straightening are typical.

It settles without surgery, with rest from stressful elbow use, but healing takes months. In 7 children (average age 10, 4 gymnasts and 3 baseball players), overhead activity and loading the arm were restricted for an average of 7 months, healing was complete at 12 months, and they were back to sport at 15 months, all with well-remodelled capitella. An age of 12 to 17, a small separate lesion, cartilage damage, loose bodies and catching point to OCD instead.

Sources 4, 26, 2, 27

What helps, and how strong the evidence is

Stable lesions: months off throwing and weight on the handsEmerging evidence

In the Japanese series, children stopped heavy use of the elbow for at least 6 months. Early lesions healed in 90.5% (stage I) and 52.9% (stage II), at mean times of 14.9 and 12.3 months, and 78.6% of stage I players returned to competitive baseball. In another series, 16 of 17 children with an open growth plate healed.

Doing it matters: only 22.7% of the 75 players who didn't follow the advice healed. Reviews give 3 to 6 months away from painful activity, with surgery to consider if 6 months of good care fail, and an expert review for gymnasts gives 6 months off sport and weights before strength and conditioning. These are case series and cohorts, not trials.

Sources 15, 22, 2, 1, 28

A cast, then a splint: one non-randomised study of 43 childrenEmerging evidence

In 43 children with stable lesions and open growth plates, a cast for about 4 weeks and then a splint for about 7 weeks, before activity restriction, was followed by complete healing in 92% at an average of 5.5 months, against 41% at 16.4 months with activity restriction alone, and a return to sport at 4.4 against 8.2 months.

The children weren't randomised, so the groups may have differed in ways that affected healing. The specialist decides whether to use a cast or splint.

Source 29

Unstable lesions and loose pieces: surgery, with good return rates in case seriesEmerging evidence

Options include removing loose pieces and drilling the base, fixing a large fragment back, or replacing the area with a bone-and-cartilage graft, often from the knee. In one cohort, 76% of 154 patients returned to their main sport; across 15 studies, 80.9% of 288 athletes returned, usually at about 6 months (3 to 12); and across 20 studies, about 11.5% of 477 elbows needed another operation, on average 25 months later. Gymnasts usually return at 6 to 8 months.

Trying rest first didn't make later surgery less successful in a US group, but a loose body made non-surgical care 13 times more likely to fail. In a US population, 82% of people diagnosed with symptomatic OCD had surgery. Surgeons disagree on many details, including when to operate on a stable lesion.

Sources 2, 7, 23, 24, 17, 8, 3, 28, 30

Long-term results: mixedMixed evidence

In an older series of 24 young people advised to rest for 6 months, 54% had elbow pain with daily activities at an average of 5 years. In a US group followed for over 10 years, elbows treated surgically had better function and fewer catching or locking symptoms (9% against 50%) than those never operated on. Continued elbow stress gave the worst results in another series. Nobody has compared the two approaches in a trial.

Sources 25, 17, 19

Panner's disease: rest, and months to healEmerging evidence

Panner's disease is treated without surgery: rest from stressful elbow activity, sometimes with a splint or cast (from 4 weeks to 11 months in published reports). Most children heal without lasting problems, but healing takes months. The evidence is case reports and small series.

Sources 4, 26, 27

Prevention: no trials, but stop at outer elbow painEmerging evidence

No prevention trial exists. For throwers, Pitch Smart (the youth pitching guidelines from Major League Baseball and USA Baseball) sets daily pitch counts and rest days; our Little League elbow guide lists them. In Japan, ultrasound screening finds most lesions at an early, treatable stage. For gymnasts, experts advise building up hand-loading volume gradually and taking elbow pain seriously.

Sources 6, 9, 3, 28

How much pain is OK while you exercise?

No pain on the outer elbow, and no catchingEmerging evidence

This rule is our editorial suggestion, with the loading advice from an expert rehab review. No study has tested a pain rule for elbow OCD. If your child's specialist or physiotherapist has given you a programme, follow theirs.

Throwing and weight through the arm: no pain on the outer elbow during, straight after or the next morning. Strength exercises: no pain in the elbow joint; a working ache in the forearm or shoulder muscles that settles within the hour is fine.

Catching, locking, new swelling or lost straightening are never part of the rule: stop and contact the specialist. When weight goes back through the arm, if it brings pain, swelling or catching, the review advises waiting 2 to 4 more weeks before trying again.

This is stricter than our rule for adults' elbow tendon pain (3 to 4 out of 10), because the joint surface of a growing bone is healing, many lesions don't hurt until they are advanced, and continued elbow stress gave the worst results in one series.

Sources 28, 3, 1, 19, 9

The exercise plan: 4 stages

Start at the first stage. Each move opens a full guide with a 3D demo.

Stage 1

Protect the elbow, keep everything else moving (often 3 to 6 months; the specialist sets the time)

No throwing, no weight on the hands (handstands, tumbling, push-ups, planks on the hands, support on bars), and no weights or heavy carrying with that arm. If the specialist uses a cast or splint, the arm exercises wait until it is off, while the legs and trunk carry on (our suggestion). Keep fit with running, cycling, legs and trunk, aiming for the NHS's average of 60 minutes of activity a day.

Elbow bend and straighten (elbow range of motion) demonstrated on the 3D figure

3D demoElbow bend and straighten (elbow range of motion)Beginner · No equipment

10 slow repetitions, once or twice a day · Never forced. The repetitions are the move page's NHS leaflet dose; how often is editorial. Report any loss of straightening

Harder: Dumbbell biceps curl

Wrist & forearm flow demonstrated on the 3D figure

3D demoWrist & forearm flowBeginner · No equipment

A few slow rounds, once a day · Pain-free. Editorial dose

Harder: Wrist flexor stretch

Glute bridge demonstrated on the 3D figure

3D demoGlute bridgeBeginner · No equipment

2 sets of 10 to 12, 3 times a week · Our Little League elbow guide's editorial dose

Easier: Pelvic tilt into bridge · Harder: Glute kickback (quadruped hip extension)

3D demoDead bugBeginner · No equipment

2 sets of 6 to 8 each side, slowly · Our Little League elbow guide's editorial dose

Harder: Forearm plank

Single-leg stand demonstrated on the 3D figure

3D demoSingle-leg standBeginner · A wall

3 holds of 30 s on each leg · Our Little League elbow guide's editorial dose

Easier: Tandem stance and heel-to-toe walk · Harder: Single-leg reach matrix

Stationary cycling demonstrated on the 3D figure

3D demoStationary cyclingBeginner · Cardio machine

20 to 30 minutes, 3 times a week · Or running. Our Little League elbow guide's editorial dose

Harder: Air bike intervals

Move on when: No pain at rest or in daily tasks, the elbow straightens fully, and the specialist sees healing on X-ray or MRI and clears strengthening.

Follow along: a timer, a cue and the next move, one step at a time.

Stage 2

Strength without weight through the elbow (once the specialist clears it)

2 to 3 sessions a week for the forearm, rotator cuff and shoulder blades, light and slow, with no pain in the elbow joint.

Wrist curls demonstrated on the 3D figure

3D demoWrist curlsBeginner · A dumbbell

2 sets of 12 to 15, palm up, a light weight · The throwing arm strength workout's dose

Easier: Wrist-extensor eccentrics · Harder: Plate pinch

Reverse wrist curl demonstrated on the 3D figure

3D demoReverse wrist curlBeginner · A dumbbell + A bench or box

2 sets of 12, light and slow · The gymnastics conditioning workout's 12; the sets are editorial

Easier: Wrist-extensor eccentrics · Harder: Plate pinch

Dumbbell forearm rotation demonstrated on the 3D figure

3D demoDumbbell forearm rotationBeginner · A dumbbell + A bench or box

2 sets of 10, a light dumbbell held near one end · The throwing arm strength workout's dose

Easier: Wrist-extensor eccentrics · Harder: Plate pinch

Standing band external rotation demonstrated on the 3D figure

3D demoStanding band external rotationBeginner · A band + An anchor point

2 sets of 12 each arm, elbow by your side · The throwing arm strength workout's dose

Harder: Side-lying external rotation

Prone Y-T-W raises demonstrated on the 3D figure

3D demoProne Y-T-W raisesBeginner · No equipment

2 sets of 5 of each shape · The throwing arm strength workout's dose

Easier: Wall angel · Harder: Bent-over reverse fly

3D demoBand rowBeginner · A band + An anchor point

2 sets of 12 with a light band · Editorial dose, lighter than the move page's starting point

Harder: Supported single-arm dumbbell row

Move on when: All of this is pain-free for 2 weeks, the elbow moves fully, strength is close to the other side, and the specialist clears loading the elbow.

Follow along: a timer, a cue and the next move, one step at a time.

Stage 3

Load the elbow again, gradually (as the specialist allows)

Gymnasts: weight through the arm in steps, from all fours (about a fifth of body weight) to the wall, an incline and hanging. Throwers: light two-handed medicine-ball throws. Every other day at first. If pain, swelling or catching appear, wait 2 to 4 weeks before trying again, as an expert review advises.

Quadruped wrist rocks demonstrated on the 3D figure

3D demoQuadruped wrist rocksBeginner · No equipment

10 slow rocks in each of 4 hand positions · The gymnastics warm-up's dose

Easier: Wrist flexor stretch

Wall push-up demonstrated on the 3D figure

3D demoWall push-upBeginner · A wall

2 sets of 10 · Editorial dose

Harder: Push-up

Incline push-up demonstrated on the 3D figure

3D demoIncline push-upBeginner · A bench or box

2 sets of 8 to 12, hands on a bench · Our wrist pain in push-ups guide's editorial dose

Harder: Push-up

3D demoBar hangIntermediate · Pull-up bar + A step

3 hangs of 10 to 20 s · Editorial dose; the gymnasts' protocols include a hanging progression

Easier: Exercise ball pyramid drape · Harder: One-arm dead hang

Medicine-ball chest push demonstrated on the 3D figure

3D demoMedicine-ball chest pushBeginner · Medicine ball

2 sets of 5 with a light ball (1 to 2 kg), both hands · Our Little League elbow guide's editorial dose

Harder: Two-hand overhead throw

Two-hand overhead throw demonstrated on the 3D figure

3D demoTwo-hand overhead throwIntermediate · Medicine ball

2 sets of 5 against a wall, light ball · Our Little League elbow guide's editorial dose

Easier: Medicine-ball chest push · Harder: Lying one-arm overhead throw

Move on when: All of this is pain-free for 2 weeks, with no catching or swelling, and the specialist clears a return to sport.

Follow along: a timer, a cue and the next move, one step at a time.

Stage 4

Back to sport, step by step

Throwers: the graded throwing steps in the notes below, within Pitch Smart's limits, with the baseball arm care warm-up before every session. Gymnasts: the return-to-gymnastics steps in our gymnast's wrist guide, with handstands and tumbling last. Keep the stage 2 strength work going twice a week.

3D demoPush-upIntermediate · No equipment

2 to 3 sets of 6 to 10 · Gymnasts. Editorial dose

Easier: Wall push-up · Harder: Close-grip push-up (close triceps position)

Half handstand at the wall (Ardha Adho Mukha Vrksasana) demonstrated on the 3D figure

3D demoHalf handstand at the wall (Ardha Adho Mukha Vrksasana)Intermediate · A wall

2 holds of 20 s · Gymnasts. The gymnastics warm-up's dose

Easier: Downward-facing dog (Adho Mukha Svanasana) · Harder: Handstand at the wall (Adho Mukha Vrksasana, chest to wall)

Lying one-arm overhead throw demonstrated on the 3D figure

3D demoLying one-arm overhead throwIntermediate · Medicine ball

2 sets of 5 each arm, light ball, to a partner · Throwers. The throwing arm strength workout's dose

Easier: Two-hand overhead throw

Half-kneeling Pallof press demonstrated on the 3D figure

3D demoHalf-kneeling Pallof pressBeginner · A band + An anchor point

2 sets of 10 each side · The throwing arm strength workout's dose

Harder: Pallof press

Thoracic rotation demonstrated on the 3D figure

3D demoThoracic rotationBeginner · No equipment

6 each side, before throwing · The move page's editorial dose

Easier: Side-lying open book · Harder: World's greatest stretch

Scapular push-up (push-up plus) demonstrated on the 3D figure

3D demoScapular push-up (push-up plus)Beginner · No equipment

2 sets of 10, on the knees first · Our Little League elbow guide's editorial dose

Easier: Dumbbell shoulder-blade punch · Harder: Pike push-up

Move on when: Full training causes no outer elbow pain, catching or swelling for 2 weeks, with follow-up imaging as the specialist advises.

Follow along: a timer, a cue and the next move, one step at a time.

What to change for now

Changing position or throwing arm isn't enoughEmerging evidence

In one small study of 33 players aged 9 to 12 with painless lesions found by screening, reported as a conference abstract, the lesion repaired completely in 93.7% of those who stopped throwing, 41.7% of those who changed position or throwing arm, and 20% of those who carried on. It is a small study, but it points the same way as the larger series: stopping throwing is the advice.

Source 31

Graded steps back to throwing (our suggestion)

No throwing programme has been validated. These steps match our Little League elbow guide's: pain-free first, short and easy before long and hard, and a step back for any pain. If your child's specialist or coach has a programme, use theirs.

1. Start only when the specialist has cleared throwing, daily life is pain-free, and the strength stage is pain-free.
2. Warm up first, for example with our baseball arm care warm-up.
3. Begin with easy, short throws on flat ground: about 25 throws at half effort to a partner about 9 to 14 m (30 to 45 feet) away, every other day.
4. Stay on each step for at least 2 pain-free sessions. Add distance first, then the number of throws, then effort, one change at a time.
5. Go back to fielding positions with fewer throws, such as first base or short spells in the outfield, before pitching or catching.
6. Pitching: flat ground first, then the mound at about half effort with a small number of pitches, building over several sessions towards game effort and the pitch count for your age.
7. Any outer elbow pain, catching or swelling during throwing, straight after or the next morning: stop for the day, rest at least a day, and restart one step lower. If it happens twice, see the specialist again.

Source 6

For parents and coaches

In a young thrower or gymnast, outer elbow pain needs checking rather than treating as tennis elbow, which is an adult tendon problem. Stop throwing and weight on the hands, ask about lost straightening, clicking and catching, and see a doctor if the elbow is swollen or painful the next day, as the American Academy of Pediatrics advises.

Throwers: count every pitch, across every team, and keep to Pitch Smart's daily limits, rest days and months off. Gymnasts: about 10% with OCD have it in both elbows, so mention any pain in the other arm.

Sources 3, 14, 8, 6

Keep the follow-up appointments

Healing is judged on X-ray or MRI, not on how it feels: with activity restriction alone, complete healing can take a year or two. Meanwhile, running, cycling and sports that don't load the arm keep fitness up, towards the NHS's average of 60 minutes of activity a day.

Sources 29, 15, 32

After surgery (as your team allows)

Your surgeon's protocol comes first. As an example, one expert protocol after a graft protects it and regains movement in weeks 1 to 4 (full straightening by week 4), adds light strengthening from week 8, and starts weight through the arm on all fours at about 12 weeks once imaging shows the graft joining, with a return-to-gymnastics phase at about weeks 28 to 32. After drilling, weight-bearing may start at about 4 months.

Surgeons most often allow a return to sport at about 6 months (3 to 12), and gymnasts at 6 to 8 months. These are typical timings, not a deadline.

Sources 28, 23, 3

Positions to swap, and why

Habit or position	Why it matters	Instead
Throwing through outer elbow pain	Continued elbow stress gave the worst results in one series, and only 22.7% of players who didn't stop healed.	Stop throwing and get it checked.
Handstands, vault and tumbling while the elbow is protected	They squash the outer elbow through a straight arm.	Legs, trunk and hand-free skills, such as the hollow body hold.Try: Hollow body hold
Push-ups before the specialist clears loading	They put body weight through the healing joint surface; even all fours takes about a fifth of body weight.	The dead bug for the trunk.Try: Dead bug
Dips	They load the elbow with body weight at a deep bend.	Leave them out until late in the return, when the specialist agrees.
Hanging and swinging on bars too early	The expert protocols add hanging only once the specialist sees healing.	Short hangs in stage 3, when allowed.
Heavy weights, or carrying heavy bags with that arm	Heavy use of the elbow was stopped in the healing studies.	The other arm, or light loads.
Forcing the elbow straight, or letting someone push it	Lost straightening can mean a loose piece or a damaged surface, and force doesn't fix it.	Gentle bending and straightening, and tell the specialist about any lost movement.Try: Elbow bend and straighten (elbow range of motion)
Year-round throwing, several teams at once, or pitching and catching on the same day	Pitch Smart advises against all three.	One team at a time, and months off each year.

Routines to follow

Shoulder mobility and stability routine (with a band)

A 25-minute band routine for healthy shoulders: move the shoulder and upper back through their range, then strengthen the rotator cuff and shoulder blades.

25 minBeginner12 movesA wall, A band

Throwing arm strength workout

A 35-minute session for baseball and softball players: the five Shoulder Control exercises, rotator cuff and forearm work, medicine-ball throws and legs.

35 minIntermediate17 movesA dumbbell, A cable machine

Baseball arm care warm-up

A 12-minute arm care warm-up for baseball and softball, built on a Japanese youth programme: an arm massage, shoulder, forearm and hip stretches, and balance.

12 minBeginner9 movesA massage ball, A wall

Gymnastics warm-up: wrists, shoulders, spine, hips and landings

A gymnastics warm-up: skips, wrist circles and rocks, shoulder work, cat-cow, hollow and arch holds, leg swings, short splits holds and landings.

15 minBeginner18 movesA band, A wall

More moves for this area

Questions people ask

What is elbow OCD?

Osteochondritis dissecans: a patch of bone and the cartilage over it, on the rounded outer end of the upper arm bone (the capitellum), weakens and can crack, loosen or come free. Repeated squashing from throwing or weight on the hands causes it in growing athletes. It has nothing to do with obsessive-compulsive disorder.

Who gets elbow OCD?

Young athletes aged about 10 to 17, mostly boys who throw and gymnasts, who are often girls. In a US population, it was diagnosed in about 15 per 100,000 boys aged 10 to 15 each year.

What are the symptoms?

Pain on the outer elbow with throwing or weight on the hands, losing some straightening, and later swelling, clicking, catching or locking. Many early lesions don't hurt: in screening programmes, between a third and two-thirds of children with OCD had ever had elbow pain.

How is it different from Little League elbow?

Little League elbow is on the inner side: a strain on the growth plate bump from the pull of throwing. OCD is on the outer side, in the joint surface, from squashing, and it takes much longer to heal. A young thrower can have both, so outer elbow pain always needs checking.

What is Panner's disease?

A related problem of the whole capitellum in children under about 10, usually boys. It settles with rest from stressful elbow use and rarely leaves problems, but healing takes months: in one series of 7 children, arm loading was restricted for about 7 months and they were back to sport at about 15. OCD is a smaller lesion in older children and can come loose.

Does my child need an MRI scan?

Usually. X-rays come first but can miss early lesions. MRI shows whether the cartilage is intact, whether fluid has got behind the fragment and whether pieces have come loose, which decides the treatment.

What do stable and unstable mean?

A stable lesion is still attached with intact cartilage, and in a child with an open growth plate and good elbow movement it usually heals with rest. An unstable lesion has cracked cartilage, fluid behind it or loose pieces, often with a closed growth plate or a lot of lost movement, and usually needs surgery.

How long does my child need off throwing or gymnastics?

For a stable lesion, months: the studies stopped throwing and weight on the hands for 3 to 6 months or longer, and healing on X-ray took over a year on average in one series. In one non-randomised study of 43 children, a cast and then a splint went with faster healing. The specialist decides, from follow-up imaging.

Will my child need surgery?

Not usually for a stable lesion when the growth plate is still open: 16 of 17 such children healed with rest in one series. Unstable lesions and loose pieces usually need surgery, from removing loose pieces and drilling to fixing the fragment or a graft. In a US population study, 82% of people diagnosed with OCD that caused symptoms had surgery.

When can my child play again after surgery?

Most children get back to their sport: 76% to 81% in studies, usually at about 6 months. Gymnasts often take 6 to 8 months. About 1 in 9 needed another operation.

Can it affect the other elbow?

In gymnasts, about 10% have it in both elbows, so doctors examine both and may X-ray both. Tell the clinician about any pain in the other arm.

Can it be prevented?

No prevention trial exists. For throwers, pitch counts, rest days and months off apply, and for gymnasts the advice is to take elbow pain seriously and build up hand loading gradually. Stopping at the first outer elbow pain gives a lesion the best chance of healing.

Related exercise guides

Other pain guides

Sources

Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.